Impact of cryoablation catheter size on success rates in the treatment of atrioventricular nodal re-entry tachycardia in 160 patients with long-term follow-up

• Published in: Europace (London, England) England), 2008-06, Vol.10 (6), p.683-686
• Main Authors: Sandilands, Alistair, Boreham, Philip, Pitts-Crick, Jonathan, Cripps, Tim
• Format: Article
• Language: English
• Subjects: Adult; Cryosurgery - adverse effects; Cryosurgery - instrumentation; Female; Follow-Up Studies; Humans; Male; Risk Assessment; Tachycardia, Atrioventricular Nodal Reentry - etiology; Tachycardia, Atrioventricular Nodal Reentry - prevention & control; Tachycardia, Atrioventricular Nodal Reentry - surgery; Treatment Outcome
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eun094

Aims To determine the efficacy and safety of cryoablation for the treatment of atrioventricular nodal re-entry tachycardia (AVNRT). Methods and results We analysed the procedural characteristics, acute success, and recurrence rates of 160 consecutive patients treated with cryoablation for the AVNRT and followed up for 18 months. Mean procedural time was 119.1 ± 3.7 min, with an average of 4.6 ± 0.2 Cryo lesions and an acute procedural success rate of 93%. Recurrence rates were 19 (11.9%) cases and were significantly higher in the 4 mm cryocatheter-treated group (12/59, 16.9%), compared with the 6 mm cryocatheter-treated group (9/101, 6.9%, P = 0.01). Recurrence rates were greater where slow pathway block was not achieved 8/12 (66.7%), compared with complete slow pathway block 11/129 (8.5%, P < 0.0001). Recurrence was significantly more likely if atrial echo beats were still present after cryoablation, 12/130 (9.2%) patients with no recurrence vs. 7/19 (36.8%) patients with recurrence (P < 0.0001). Conclusion Cryoablation is a safe and efficacious treatment for AVNRT. Complete slow pathway block is associated with long-term success, together with the use of the larger 6 mm cryocatheter. There is always a risk of heart block with radiofrequency ablation, although this experience confirms previous findings that the risk with Cryo is zero.